Are too many older people screened for cancer?
Many older Americans get screened for colon, breast, prostate and cervical cancer even though guidelines recommend against routinely screening the elderly, a new study finds.
As the population of the United States continues to age, balancing good health care with costs will be a continuing battle, experts say.
"In an era of escalating health care utilization and expenditures in the United States, identifying areas for cost containment while concurrently improving quality of care in our health care system is increasingly paramount," said lead researcher Keith Bellizzi, an assistant professor of human development and family studies at the University of Connecticut in Storrs.
"Perhaps this area of health care warrants further attention," Bellizzi added.
Currently, nearly 37 million people in the United States are 65 and older, and that number will probably double by 2030. Historically, older adults have been excluded from cancer clinical trials, so what is known about the effectiveness of screening in seniors is limited, he said.
The U.S. Preventive Services Task Force recommends against routine screening for breast, colorectal, and prostate cancer at age 75 and beyond, and advises against cervical cancer testing after 65, according to the study.
But many older adults today live longer, healthier lives than earlier generations, so it is likely that continued screening for certain segments of the older adult population is warranted, he said.
"At the same time, there are segments of the older adult population with limited life expectancy, poor health status and concommitant health conditions that would likely not benefit from screening. The challenge is, how do we make this determination?" Bellizzi said.
To asses the prevalence of screening among the elderly, Bellizzi's team collected data on almost 50,000 men and women who took part in the U.S. National Health Interview Survey.
Among women 75 to 79 years old, 62 percent had received a mammogram to screen for breast cancer in the past two years, as had 50 percent of women 80 and older. Pap screens for cervical cancer were done on 53 percent of women 75 to 79, and 38 percent of women 80 and older, the researchers found.
Fifty-seven percent of men and women 75 to 79 were screened for colon cancer in the previous two years.
Prostate cancer screening was undertaken by 57 percent of those 75 to 79; 42 percent of men 80 and older; and 40 percent of those 50 to 74, the researchers found.
The study is published in the Dec. 12/26 issue of the Archives of Internal Medicine.
People over 75 were most likely to be screened for breast, colorectal, and prostate cancer if a doctor recommended it, Bellizzi's team found. Also, college-educated men and women were most likely to be screened, while those without a high school diploma were least likely to get screened.
There is no "one size fits all solution," Bellizzi said. "Screening decisions should be individualized based on life expectancy, health status, an informed discussion with the patient about the potential harms and benefits, and patient values and preferences."
Dr. Louise C. Walter, an assistant professor of medicine at the University of California, San Francisco, and author of an accompanying journal editorial, agreed that age should not be the sole determinant of screening.
"What you really want to do is encourage individualized decisions," Walter said, suggesting that doctors weigh general health and life expectancy before recommending cancer screening.
"There are lots of very healthy people that have long life expectancy, and cancer increases as you get older, so it makes sense to get screened," she said.
But there are also a lot of very ill people for whom screening can be harmful, she added, referring to the hazards of certain procedures and treatments that might not save lives.
Dr. Otis Brawley, chief medical officer at the American Cancer Society, conceded some elderly Americans might be candidates for screening, but said "the overwhelming majority of folks over 75 should not be getting these screening tests, because we have no science that shows these tests are going to benefit these folks by making them live longer."
"This is an example of waste," he said. "We need to think about the rational use of health care and stop talking about the rationing of health care.
"Many docs are ordering these test purely to cover themselves" from a lawsuit, he added.
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